What We Treat

Anorectal Pain

Anorectal pain problems include Fistula, Fissure, Abscess and Warts.

What Is An Anal Fistula?

An anal fistula is an abnormal tunnel between the anal canal and the outer skin of the anus.

What causes a fistula?

An anal fistula usually results from a previous infection (abscess) of the anus or rectum. After an abscess has been drained, a tunnel may persist connecting the anal gland from which the abscess arose to the skin. Inflammatory diseases of the anorectal area, such as Crohn’s disease, can predispose a person to the development of anal fistulas, but again, most fistula patients do not have an underlying illness.

What Are The Symptoms Of An Anal Fistula?

Pain, Redness, or swelling in the anal area

Drainage of fluid in the anal area that may be clear, cloudy, bloody, or foul-smelling

Itching or irritation of the skin around the anus

Leakage of stool between bowel movements

Fever

What Is The Treatment For An Anal Fistula?

Surgery is always required to cure an anal fistula. Some patients do take antibiotics to reduce inflammation, but this will not cure the problem. The procedure is called a fistulotomy and involves opening the tunnel. This converts the tunnel into a groove which will then heal from the inside out. Most fistulas must be treated in the operating room under general anesthesia. It is almost always a short outpatient procedure. If the fistula is complex and goes through a lot of anal sphincter muscles, more complicated techniques may be necessary. After the surgery, a period of rest and recovery is required. Medications to soften bowel movements and pain medication are prescribed. Bowel movements do not affect healing. Warm soaks to clean the anal area and provide pain relief are also recommended. Most patients are back to regular activities within a few days.

What Is An Anal Fissure?

An anal fissure is a tear or cut in the lining of the anus. Anal fissures are a common problem and may sometimes be confused with hemorrhoids. Anal fissures can affect people of any age group, but are more common in people under age 50.

What Are The Symptoms Of An Anal Fissure?

Symptoms of an anal fissure include:
• Sharp pain during and after bowel movements. Pain is often severe.
• Bright red blood with bowel movements, which may be on the stool, in the toilet bowel, or on toilet paper you have used.
• Spasm in the sphincter muscles of the anus, caused by irritation of the tear during a bowel movement.
• An anal fissure may give rise to a “sentinel pile”, which is a skin tag along the edge of the anus next to the fissure. This is sometimes confused with a hemorrhoid.

What Causes Anal Fissures?

A tear in the anal lining can occur with:

Hard, dry bowel movements

Straining to have a bowel movement when constipated

Diarrhea

Inflammatory diseases of the anorectal area such as Crohn’s disease

What Is The Treatment For An Anal Fissure?

An acute anal fissure is managed with non-operatively and can usually be treated by:

Fluids – Drinking plenty of fluids helps soften bowel movements so they are easier to pass.\

Warm Soaks – Sitting in warm water, 2-3 times a day for 15 minutes helps prevent spasm of the sphincter muscles and provides pain relief.

Medications – Your doctor can prescribe creams or suppositories that help relieve pain, spasm, and inflammation.

Chronic Anal Fissure Treatment

A chronic anal fissure that does not heal despite the above measures should be treated with a small simple operation called a sphincterotomy. This procedure is usually done under anesthesia, takes a few minutes, and patients go home the same day as outpatients. During this procedure a few fibers of the internal anal sphincter muscle are cut. This decreases spasm in the muscle and allows the fissure to heal. Most patients have a significant reduction in their discomfort immediately after the surgery, and many can go back to work and resume normal activities the following day. Almost all patients (greater than 95%) have rapid healing after surgery and no further trouble with an anal fissure.

What Is An Anorectal Abscess?

Anorectal abscesses are common benign conditions that present as a painful swelling near the anal opening. It results from an infected gland just inside the anus that subsequently develops into an infected cavity filled with pus.

What are the symptoms associated with anorectal abscess?

The symptoms that occur include pain and pressure in the anorectal area. The pain is often severe. There is frequently some swelling and redness around the anorectal area. Sometimes, spontaneous drainage of pus can occur. The area is usually very tender to touch. Fever and chills may also be present.

What treatment is prescribed for an anorectal abscess?

The primary treatment of any anorectal abscess is surgical drainage of the pus. Even if the abscess has opened and pus is draining a procedure is still needed to completely eradicate the infection. Patients often feel a tremendous relief and improvement upon waking up from surgery. Many can go back to work the next day.

What Are Anal Warts?

Anal warts, also known as condyloma acuminata or venereal warts, are a relatively common and bothersome condition that affects the area around the anus. They may also affect the moist tissues of the genital area. They may look like small, flesh-colored bumps or have a cauliflower-like appearance, perhaps as small as the head of a pin, or may multiply into large clusters. Usually, they do not cause any type of pain or discomfort to afflicted individuals. As a result of this, patients may be unaware that the warts are present.

Where do these warts come from?

They are thought to be caused by the human papilloma virus –HPV- which infects the top layers of your skin. The virus is highly contagious and spreads through sexual contact with an infected person.

Do these warts always need to be removed?

Yes. It is critical because the virus may continue to be present and cause new anal warts to form. There is a possibility of serious problems if the warts are left untreated and can become cancerous.

What treatments are available?

There are several ways anal warts can be treated, depending on the location, number, and size of the warts. If the warts are small, they can be treated with solutions (podophyllin or bichloracetic acid) which are applied directly to the warts intended to cause exfoliation of the warts. This method usually requires several applications at various intervals over several weeks to ensure removal.
Another form of treatment is cauterization. The area is numbed with local anesthesia before the warts are burned off. If there are numerous warts, the doctor may choose to remove them surgically.

Warts that are located inside the anal canal are usually not suitable for treatment with medications and in the majority of cases need to be treated with cauterization or are surgically removed. Surgery requires anesthesia, but patients are released the same day as outpatients.

Will a single treatment cure the problem?

In half of all patients with warts, a single treatment will completely cure the problem. Close follow-up is critical because the virus may continue to be present and cause new warts to form. New or recurrent warts are treated similarly.

How long is treatment usually continued?

Follow-up visits are necessary even after there are no visible warts. Visits may be necessary for up to six months to make certain the virus is not living in the cells of the skin.